Tuesday, May 12. 2009

The article by Carlton Erickson is of course relating to use of drugs illegally and it should be read in that context. People made dependent by doctors do not usually warrant such musings unfortunately but there are points here worth considering and of course parallels. What the article says to me is that the indiscriminate long-term overprescribing of tranquillisers stimulates brain disease. The article also highlights the need for dedicated and informed care and compassion - something which those made dependent by doctors universally lack. The reference to neurotransmitters is what particularly struck me in this article. Professor Heather Ashton has said in the past that some people may be more affected by prescribed tranquilliser dependence because the natural level of GABA may vary in individuals and the effect on those individuals given tranquillisers may therefore be more severe.

To summarise, the first article (even though it is talking about the illegal scene) clearly states that long term addicted people are dependent and are not abusers. They need to be seen differently and need help. The second article emphasises the reality of how the DoH offers no help to patients addicted to tranquillisers by doctors, preferring to assert they are drug abusers.

From the Erickson article: "Dependence is “impaired control” over drug use, probably caused by a dysfunction in the brain's pleasure pathway. This is the disease of addiction, an “I can't stop without help” disease. It requires formal therapy and/or 12 steps and might require anti-craving drug therapy.

The DSM-IV criteria for chemical dependence are:

1) a maladaptive pattern of drug use, leading to impairment or distress, presenting as three or more of the following over a 12-month period –• tolerance to the drug's actions• withdrawal (generally, physical withdrawal)• drug is used more than intended• there is an inability to control drug use• effort is expended to obtain the drug• important activities are replaced by drug use, and• drug use continues despite negative consequences

Dependence is probably due to a functional dysregulation – meaning: they aren't working right! – of one or more neurotransmitter chemicals in the MFB. These include dopamine (which is affected by cocaine, amphetamines or alcohol), serotonin (alcohol or LSD), endorphins (alcohol or opioids such as heroin), gamma-aminobutyric acid (alcohol or benzodiazepines – antianxiety agents), glutamate (alcohol) and acetylcholine (nicotine or alcohol)."